Person: DURAK, VAHİDE ASLIHAN
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DURAK
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VAHİDE ASLIHAN
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Publication The comparison of pecarn, catch, and chalice criteria in children under the age of 18 years with minor head trauma in emergency department(Sage Publications Ltd, 2020-06-14) Gizli, Gizem; Durak, Vahide Aslıhan; Köksal, Özlem; DURAK, VAHİDE ASLIHAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; 0000-0003-0836-7862; AAE-9483-2021Introduction: Minor head traumas constitute a significant part of childhood injuries. The incidence of intracranial pathologies in children with minor head trauma varies in the range of 3%-5%, but it is higher among younger infants. The criteria of the Pediatric Emergency Care Applied Research Network, Canadian Assessment of Tomography for Childhood Head Injury, and Children's Head Injury Algorithm for the Prediction of Important Clinical Events are the most frequently accepted clinical decision-making criteria that were developed for selective computerized tomography requests. This study was conducted to assess the diagnostic performances of the Pediatric Emergency Care Applied Research Network, Canadian Assessment of Tomography for Childhood Head Injury, and Children's Head Injury Algorithm for the Prediction of Important Clinical Events criteria in Turkish society, determine their validity, and find the most suitable algorithm for cranial imaging in children with minor head trauma. Methods: This study retrospectively examined the data of patients under the age of 18 years who were admitted to the Emergency Medicine Department of Uludag University Medical Faculty due to minor head trauma; 530 patients were included as they complied with the criteria. The exclusion criteria were being any trauma patients above the age of 18 years, Glasgow Coma Scale <13, pregnant patients, hemorrhagic diathesis, using anticoagulants, patients with penetrant trauma, patients with priorly known brain tumor, and patients with neurological diseases. The patients were divided into group based on the Pediatric Emergency Care Applied Research Network, Canadian Assessment of Tomography for Childhood Head Injury, and Children's Head Injury Algorithm for the Prediction of Important Clinical Events Criteria. Results: Among all patients, 37.40% were female and 62.60% were male. Abnormal computed tomography findings such as epidural bleeding, subdural bleeding, and skull fractures were detected in 44 of the patients. The sensitivity of the Pediatric Emergency Care Applied Research Network criteria was 72.4%, the specificity was 54.5%, the sensitivity of the Canadian Assessment of Tomography for Childhood Head Injury criteria was 57.8%, the specificity was 50%, the sensitivity of the Children's Head Injury Algorithm for the Prediction of Important Clinical Events criteria was 87.7%, and the specificity was 20%. Conclusion: Given the populations to which the rules apply, it is understood that the Children's Head Injury Algorithm for the Prediction of Important Clinical Events criteria is more determinative in detecting pathological computed tomography outcomes compared to Pediatric Emergency Care Applied Research Network and Canadian Assessment of Tomography for Childhood Head Injury.Publication Kimura's disease: A rare disease with cervical lymphadenopathy(Pakistan Medical Association, 2020-09-01) Durak, Vahide Aslıhan; DURAK, VAHİDE ASLIHAN; Bursa Uludağ Üniversitesi/Acil Tıp Anabilim Dalı.; 0000-0003-0836-7862; AAE-9483-2021Kimura's disease is a very rare disorder and causes swellings and lymphadenopathy, especially in neck and axillary region. The aetiology is still unknown but allergic reactions or an alteration of immune system should be taken into consideration.Here, we report a 45-year-old Turkish male patient who presented to the Uludag University Medical Faculty Emergency Medicine Department with complaint of enlarged lymph nodes in the neck region and pruritus. His leukocyte count and eosinophil rate were found to be elevated in the emergency laboratory results. During his follow up the nodes were removed and histopathologically evaluated as Kimura's disease.In conclusion, one can say that the diagnosis of Kimura's disease can be very difficult and histopathological features play an important role. However, this diagnosis should not be underestimated in young male patients with lymph nodes in cervical area especially in the emergency department.Publication Diagnostic accuracy of fresno-quebec rules and risk factors for an associated fracture in patients presenting to the emergency department with anterior shoulder dislocation: A retrospective study(Turkish Assoc Trauma Emergency Surgery, 2021-01-01) Durak, Vahide Aslihan; DURAK, VAHİDE ASLIHAN; Atici, Teoman; ATICI, TEOMAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; 0000-0003-0836-7862; 0000-0002-3396-3407; AAE-9483-2021BACKGROUND: Anterior shoulder dislocation is the most common shoulder injury in patients presenting to the emergency department (ED). Up to 25% of these injuries are fracture-dislocations. In general, the standard approach is to obtain plain radiographs before and after reduction. Fresno-Quebec Rules (FQR) are described to identify the patients who require an x-ray before reduction to reduce radiation exposure and delays in treatment. We aimed to evaluate the efficacy of clinical predictors used in the Fresno-Quebec algorithm for detecting a shoulder fracture-dislocation.METHODS: Records of patients who presented to the Emergency Department with presumed shoulder dislocation were retrieved and retrospectively analyzed according to 'Fresno-Quebec Rule (FQR)'. Sensitivity, specificity, and predictive values of FQR for detecting associated injuries were calculated.RESULTS: Eighty-nine (65.9%) men and 46 (34.1%) women were included. The mean age of patients was 46 years (16-89). Ninety-nine (73.3%) of the cases had their shoulder dislocated for the first time, whereas 36 (26.7%) patients had a recurrent dislocation. Fifty percent of the patients (18 cases) with recurrent dislocation presented with an atraumatic episode. The remaining 18 patients with a history of recurrent dislocations had their shoulder dislocated as a result of trauma, and four (22%) of them had fracture-dislocation. Using the Fresno-Quebec rules yielded 100% specificity for the diagnosis of fracture-dislocation. The severity of the injury mechanism was not predictive in traumatic but recurrent dislocations. Only one of four patients with a fracture-dislocation in the traumatic recurrent dislocation group had high energy trauma.CONCLUSION: FQR has 100% sensitivity in detecting fracture-dislocations in patients admitted to ED with anterior shoulder dislocation. It utilizes simple parameters that are easy to use and recall. Using these rules, 30% of unnecessary radiographs can be avoided, saving time and money and reducing radiation exposure in anterior dislocations.Publication Rhinocerebral mucormycosis case in the emergency room(Acil Tıp Hekimleri Derneği Türkiye, 2021-12-01) Aslan, Şahin; Omar, Issa; Durak, Vahide Aslıhan; Cıkrıklar, Halil İbrahim; Özdemir, Fatma; ASLAN, ŞAHİN; OMAR, ISSA MALONGO; DURAK, VAHİDE ASLIHAN; ÇIKRIKLAR, HALİL İBRAHİM; ÖZDEMİR, FATMA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı; 0000-0003-0836-7862; 0000-0002-6665-7166; EMD-3139-2022; GXT-8042-2022; AAE-9483-2021; AAH-8714-2021; JRF-5591-2023Introduction: Rhinocerebral mucormycosis is a rare disease, which causes serious and life-threatening fungal infections.The disease usually develops in immunocompromised individuals and usually begins by mimicking cellulite, especially in the face area, and shows a very rapid course.Case Report: A 75-year-old male patient previously admitted to an external center with 3-4 days complaints of headache, numbness in the right half of his face and closure of his left eye was brought to our emergency department for further investigation.The cranial magnetic resonance imaging (MRI) revealed suspected opportunistic fungal infection or malignancy in the ethmoidal and sphenoidal sinuses.The patient was hospitalized with the diagnosis of opportunistic fungal infection after consultations to relevant clinics. Biopsy revealed polypes and mucocele like cystic tissues. The patient, followed-up and treated with rhinocerebral mucormicosis, was transferred to intensive care unit after deterioration of his general condition.After approximately 45 days of follow-up and treatment, the patient was lost due to multiple organ failure.Conclusion: Rhinocerebral mucormycosis is an emergency that requires a multidisciplinary approach. Presence of one or more of the non-traumatic orbital apex syndrome findings should alert emergency physicians. In this and similar infections with high mortality rates, early diagnosis and treatment may lead to good results.Publication The combination of scoring systems and lactate for predicting short-term mortality in geriatric patients with dyspnea(Springer, 2023-06-19) Ardıç, Anıl; Köksal, Özlem; Durak, Vahide Aslıhan; Dilektaşlı, Aslı Görek; Özkaya, Güven; KÖKSAL, ÖZLEM; DURAK, VAHİDE ASLIHAN; GÖREK DİLEKTAŞLI, ASLI; ÖZKAYA, GÜVEN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı; 0000-0003-0836-7862; 0000-0003-0297-846X; 0000-0003-2271-5659; AAK-8332-2020; AAE-9483-2021; CNP-1063-2022; IVU-2672-2023BackgroundDyspnea is one of the most common causes for admission to the emergency department. Lactate (L), which can be used as a prognostic marker, was first studied by Broder and Weil and it was shown that a level > 4 mmol/l is associated with a poor prognosis. There are also scoring systems to assess the severity of illness of patients presenting to the emergency department such as the National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS) and VitalPAC Early Warning Score (ViEWS).ObjectivesIn this study, we aimed to investigate the combination of risk scoring systems and lactate in predicting short-term mortality in patients over 65 years of age with the complaint of nontraumatic dyspnea.Materials and methodsThe population of the study consisted of adult patients aged 65 and over who presented to Bursa Uludag University Medical Faculty Emergency Department with dyspnea. Admission NEWS, MEWS, REMS, ViEWS scores and their combined forms with added lactate levels at first admission, and 7-, 14-, and 28-day survival were recorded.ResultsWe found that the modified composite scores with lactate value, and the NEWS, MEWS, REMS, and ViEWS scores could predict the 28-day mortality. Ranking the scores and lactate value predicting 28-day mortality according to the area under the curve (AUC) value revealed that the 28-day mortality was best predicted by the NEWS + lactate with 64.97% sensitivity and 77.53% specificity (p < 0.001). We have shown that increasing lactate levels, NEWS, MEWS, REMS, ViEWS scores and their modified composite scores with lactate above suggested thresholds are independent risk factors for increased mortality in multivariable Cox regression analysis.ConclusionsIn cases with dyspnea, lactate value, NEWS, MEWS, REMS, ViEWS, NEWS-L MEWS-L, REMS-L, and ViEWS-L scores can be used to predict early mortality. Risk scores modified with lactate value were found to be more successful in predicting 28-day mortality.Publication Association of clinical characteristics with decision making in patients with severe lower extremity trauma(Mre Press, 2021-01-01) Durak, Vahide Aslıhan; Ermutlu, Cenk; Atıcı, Teoman; DURAK, VAHİDE ASLIHAN; ERMUTLU, CENK; ATICI, TEOMAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Bölümü; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi Bölümü ve Travmatoloji; 0000-0003-0836-7862; 0000-0002-3396-3407; AAE-9483-2021; AEQ-5464-2022; A-5095-2018Severe lower limb trauma represents a challenge for both the emergency department physicians and the surgeons. These injuries are associated with significant incidence of limb loss and it is not uncommon for the treating physician to make the hard decision between limb salvage, amputation or stump closure for a patient in critical condition. Our aim was to evaluate the epidemiology of traumatic lower extremity amputations and to analyze the factors which may have effect on patient resuscitation, limb salvage and efficient patient management. Patients who were admitted to our institution's emergency department for traumatic lower extremity amputation over an 8 years' period (2012 to 2020) were retrospectively analyzed. Patient files with the possibility of severe lower limb trauma and mangled extremity were retrieved and analyzed using ICD codes recorded/registered during the emergency department admission. Mean time from emergency admission to transfer to operating theater was 184,5 minutes. Replantation of the amputate was performed in 4 patients (19%). 25% of the amputations at the ankle level (1 out of 4) and 37.5% of the transtibial amputates (3 out of 8) were replanted. A multidisciplinary approach is necessary in every aspect of patient management; however, this does not justify a delay in treatment. Time spent during conclusion of necessary consultations does not have negative effects on patient outcome as long as patient is closely monitored and resuscitated in the emergency department.Publication Covid-19 pandemic and anxiety related factors in patients treated in the emergency department(Mre Press, 2020-10-01) Durak, Vahide Aslihan; DURAK, VAHİDE ASLIHAN; Günay, Seyda; GÜNAY POLATKAN, ŞEYDA; Sığırlı, Deniz; SIĞIRLI, DENİZ; Akova, Bedrettin; AKOVA, BEDRETTİN; Armağan, Erol; ARMAĞAN, EROL; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Kardiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi /Spor Hekimliği Anabilim Dalı; 0000-0003-0836-7862; 0000-0003-1044-8805; AAA-7472-2021; AAI-4550-2021; AAH-8846-2021; AAI-5350-2021Aims: A novel coronavirus, now known as SARS-CoV-2019, suddenly emerged in Wuhan, China and within threemonths of the initial outbreak, the virus had spread rapidly to neighboring countries causing a pandemic. After the first case was announced, emergency departments were immediately reorganized as pandemic clinics. Special areas with maximum precautions were designed to evaluate patients. The majority of studies on this pandemic have focused on the treatment of respiratory symptoms and comorbidities in intensive care units. In this study, we sought to determine those factors that contributed to the anxiety level during the COVID-19 pandemic using the 'State' subscale of State-Trait Anxiety Inventory (STAI-S). Methods: A survey was performed in the emergency department by using an online questionnaire which consisted of demographic variables, questions about the opinions and behaviors of patients during the pandemic, diagnostic test results for COVID-19, and treatment methods. Results: There was a statistically significant difference between employment status (p < 0.001), monthly income (p < 0.001), the food consumption changes during the pandemic period (p = 0.001) and the estimated end-date for the COVID-19 pandemic (p < 0.001) and total STAI-S points. Conclusions: Our study has identified factors which significantly increase anxiety during the COVID-19 pandemic and identified those individuals who may benefit from psychiatric and social support.Publication The predictive value of triage early Warning Score (TEWS) on mortality of trauma patients presenting to the Emergency Department(Edizioni Luigi Pozzi, 2019-03-01) Torun, Gökhan; Durak, Vahide Aslıhan; DURAK, VAHİDE ASLIHAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; AAE-9483-2021INTRODUCTION: Posttraumatic injuries are among the most frequent reasons of admission to emergency room services (ERs). In the first assessment of the cases, ATLS protocols recommends use of triage decision scheme consisting of parametres of abnormal physiologic findings, anatomic injury site, pathogenic mechanism of injury, concomitant diseases and conditions, and activation of trauma teams in line with these criteria. The aim of this study is to evaluate TEWS(Triage Early Warning Score) as a marker for predicting mortality in trauma patients who presented to Emergency Services.MATERIALS AND METHODS: 381 trauma patients aged >= 18 years who admitted to the Emergency Service and met criteria of ATLS protocol were included in the study. TEWS values of the patients were calculated using patients data included in the study forms. Impact level was scrutinized using multivariant logistic regression test. Level of statistical significance was accepted as p<0.05.RESULTS: In the prediction of survival and ex patient rates; significant effectiveness of TEWS was observed [0.973 (0.944-1)] (p<0.05). In the ROC analysis maximum TEWS AUC value was [0.930 (0.895-0.966)1 with a cut-off value of 5 points. TEWS scores of 17.2% (66/381) of the patients who were discharged were above 5 points. These patients had undergone intubation (n= 21; 35%), tube thoracostomy (n= 16; 266%), transfusion of blood products (n= 29; 48.3%), and emergency surgery (n=16; 266%).CONCLUSIONS: Triage Early Warning Score is effective in the prediction of emergency treatment, and prognosis in trauma patients hospitalized in the emergency services, and it may identify patients under risk. We think that Triage Early Warning Score together with ATLS protocol can be used as an easily applicable triage warning trauma score in trauma patients.